Endoscopy 2019; 51(04): S213-S214
DOI: 10.1055/s-0039-1681806
ESGE Days 2019 ePosters
Friday, April 5, 2019 09:00 – 17:00: Colon and rectum ePosters
Georg Thieme Verlag KG Stuttgart · New York

DON'T FORGET TO PERFORM BIOPSIES IN NORMAL ILEOCOLONOSCOPY FOR CHRONIC DIARRHEA

G Leoncini
1   Pathology Unit, ASST del Garda, Desenzano del Garda, Brescia, Italy
,
F Bonfante
2   Internal Medicine, Desenzano Hospital – ASST Garda Brescia, Desenzano del Garda, Italy
,
O Bonzanini
3   Internal Medicine, Gavardo Hospital – ASST Garda Brescia, Gavardo, Italy
,
S Polo
3   Internal Medicine, Gavardo Hospital – ASST Garda Brescia, Gavardo, Italy
,
G Aimo
2   Internal Medicine, Desenzano Hospital – ASST Garda Brescia, Desenzano del Garda, Italy
,
V Villanacci
4   Pathology Unit, ASST Spedali Civili, Brescia, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

The aim of the present study is to better assess the prevalence of colitis with unremarkable endoscopic features, through clinical-pathological correlations.

Methods:

150 patients (96 women. age 18 – 72 y) with chronic diarrhea were retrospectively evaluated, from 2008 to 2018. IBD, diverticular disease, HIV infection, parasites infestations, neoplasms were excluded. Every patient underwent a complete ileo-colonoscopy with a bioptic mapping from the terminal ileum to the rectum, providing from a minimum of two biopsies from each explored intestinal segment; biopsies were correctly oriented on acetate cellulose filters. The ileo-colonoscopy was performed with white light instruments without high definition and magnification. The bioptic samples were sent to our Pathology Unit, formalin-fixed, paraffin-embedded and stained with Hematoxylin-Eosin (H-E). Microscopic examination was performed by two GI pathologist on H-E, Masson trichrome stain and immunohistochemical stains for CD3 and CD8 iin selected cases.

Results:

The histopathologic examination confirmed the presence of microscopic colitis (MC) in 43 of 150 patients (29%), with predominance of linfocitic colitis (LC) (16%) over collagenous colitis CC (13%). The remaining 71% was composed by the resolving phase of acute self-limiting colitis (ASLC-r; 28%), by iatrogenic colitis (IC; 26%), with both hypereosinophilic (21%) and pseudo-melanotic (5%) pattern of injury, and histologically normal mucosa (NM; 17%).

Conclusions:

When we perform colonoscopy for chronic diarrhea and endoscopic features are not remarkable, a complete bioptic sampling is mandatory, because the classic MC is not the only possible scenario in the normal mucosa. Our data suggested that MC are responsible for less than one third of cases of chronic diarrhea. Other conditions, such as ASLC-r and IC, are involved as causative factors of diarrhea and they might be better understood on both clinical and pathological ground. Further studies with endoscopic high definition techniques are needed to rule out the intrinsic limitation of the low definition imaging.